Abnormal Development - Tuberculosis

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More than two billion people, one third of the world's total population, are infected with TB bacilli, an airborne infectious disease that is preventable and curable. The Bacillus Calmette-Guérin (BCG) vaccine was first used in 1921 as a vaccine for tuberculosis disease and also used in some countries to prevent childhood tuberculous meningitis and miliary disease.

Congenital tuberculosis cases are rare with a relatively high mortality rate.[1]

Postnatal infant infection can occur as a result of inhalation of bacilli at or soon after birth, ingestion of infected breast milk, or contamination of traumatized skin or mucous membranes.

Some Recent Findings

Fact and fiction in tuberculosis vaccine research: 10 years later[2] "Tuberculosis is one of the most deadly infectious diseases. The situation is worsening because of co-infection with HIV and increased occurrence of drug resistance. Although the BCG vaccine has been in use for 90 years, protection is insufficient; new vaccine candidates are therefore needed. 12 potential vaccines have gone into clinical trials."

Increased risk of low birthweight and small for gestational age infants among women with tuberculosis[3] "We concluded that women diagnosed with TB during pregnancy are at increased risk for having low birthweight (LBW) and small for gestational age (SGA) babies, compared with unaffected mothers. We suggest that clinicians should make women with TB aware of the potential risks before planning a child."

More recent papers

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Global Tuberculosis (new cases 2007)

Drug-Resistant Tuberculosis

Extensively drug-resistant tuberculosis (XDR-TB2) is a highly drug-resistant strain subset of multidrug-resistant TB (MDR-TB) that have significantly worse outcomes, has now been reported in more than 50 countries. (WHO data)

Multidrug-resistant tuberculosis (MDR-TB) is defined as resistance to the two most powerful first-line anti-TB drugs (isoniazid and rifampicin).

Extensively drug-resistant tuberculosis (XDR-TB2) is defined as MDR-TB plus resistance to the most powerful second-line anti-TB drugs (any fluoroquinolone and any of the three injectable drugs: amikacin, capreomycin and kanamycin).

Australian Recommendations

BCG vaccination is not recommended for general use in the Australian population.

BCG is recommended for:

Aboriginal neonates in areas of high incidence of TB (e.g. Northern Territory, Far North Queensland, northern areas of Western Australia and South Australia).

neonates and children 5 years and under who will be travelling or living in countries or areas with a high prevalence of TB for extended periods.

neonates born to parents with leprosy or a family history of leprosy.

In addition to these recommendations BCG may be considered in the following:

Children over 5 years who will be travelling or living in countries or areas with a high prevalence of TB for extended periods.

Health care workers (HCWs) who may be at high risk of exposure to drug resistant cases.

(Text Source: Communicable Diseases Intelligence Volume 30 Number 1, March 2006 - The BCG vaccine: information and recommendations for use in Australia)

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